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van Erp MAJM, Maassen LW, van Gastel DM, Koks CAM, Bongers MY, Veersema S. Essure removal surgery: Are preoperative transvaginal ultrasound and pelvic X-ray necessary? Eur J Obstet Gynecol Reprod Biol 2023; 286:102-106. [PMID: 37235926 DOI: 10.1016/j.ejogrb.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/10/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The objective of this study was twofold. (1) To investigate the predictive characteristics of transvaginal ultrasonography for hysteroscopy necessity in Essure removal surgery. (2) To investigate the additional predictive value of a preoperative pelvic radiograph to transvaginal ultrasonography for hysteroscopy necessity. STUDY DESIGN Retrospective cohort study, performed in an academic and a non-academic teaching hospital in the Netherlands. 71 women who underwent Essure removal surgery with a perioperative hysteroscopy and who had a preoperative pelvic X-ray and transvaginal ultrasound were included. Four experts first predicted hysteroscopy necessity based on transvaginal ultrasound description and secondly based on transvaginal ultrasound combined with the preoperative pelvic radiograph. Sensitivity, specificity, positive predictive value and negative predictive value of the predictive tests were calculated. RESULTS Based on transvaginal ultrasound, the mean predictive characteristics for experts were: sensitivity 89.7% (range 66.7%-100%), specificity 37.4% (range 17.6%-67.7%), positive predictive value 18.8% (range 13.2%-29.5%) and negative predictive value 95.1% (range 86.1%-100%). After adding the pelvic radiograph to the transvaginal ultrasound descriptions, the results were: sensitivity 66.7% (range 53.3%-80%), specificity 72.6% (range 56%-97.3%), positive predictive value 23% (range 14.3%-26.9%) and negative predictive value 94.1 % (range 90.3%-98.4%). For three experts sensitivity decreased after adding the pelvic radiograph. For all experts specificity increased. CONCLUSION It is difficult to preoperatively decide if the fourth marker of the Essure outer coil can be excised during hysteroscopy. The addition of pelvic radiography to transvaginal ultrasound is not beneficial. It is recommended to perform a hysteroscopy during Essure removal surgery.
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Affiliation(s)
- Mirthe A J M van Erp
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Liselotte W Maassen
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Danielle M van Gastel
- Research School Grow Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Carolien A M Koks
- Maxima Medical Center, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - Marlies Y Bongers
- Research School Grow Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; Maxima Medical Center, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - Sebastiaan Veersema
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Crofton K, Marici E, Wilson-Leedy JG. Essure Device Migration After Bilateral Partial Salpingectomy at Time of Cesarean Section. J Minim Invasive Gynecol 2022; 29:596-598. [DOI: 10.1016/j.jmig.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 11/16/2022]
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Challenges in Removing the Essure ® Device. Case Rep Obstet Gynecol 2020; 2020:8823606. [PMID: 32908744 PMCID: PMC7468664 DOI: 10.1155/2020/8823606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022] Open
Abstract
We present a case about Essure® removal surgery in which the third markers of the device have torn off. The woman needed a second surgery for complete removal of the devices. Fluoroscopy during surgery is a good method to visualize the lost fragments. With fluoroscopy, a hysterectomy is not needed for complete removal. It is important to understand the structure of the device and to be aware of the four radiopaque markers during surgery and their removal.
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Chene G, Lamblin G, Mezzetta L, Lablanche O, Cerruto E, Nohuz E. [How I do… easily laparoscopic residual Essure® resection without hysterectomy?]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:768-771. [PMID: 32522614 DOI: 10.1016/j.gofs.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Indexed: 10/24/2022]
Affiliation(s)
- G Chene
- Département de gynécologie, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France; EMR 3738, université Claude Bernard Lyon 1, 69000 Lyon, France.
| | - G Lamblin
- Département de gynécologie, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - L Mezzetta
- Centre d'imagerie médicale Charcot, 53, rue du Commandant Charcot, 69110 Sainte-Foy-lès-Lyon, France
| | - O Lablanche
- Département de gynécologie, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - E Cerruto
- Département de gynécologie, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - E Nohuz
- Département de gynécologie, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France
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Miquel L, Crochet P, Francini S, Compan C, Boubli L, Agostini A. Laparoscopic Essure® Device Removal by En Bloc Salpingectomy-Cornuectomy with Intraoperative X-Ray Checking: A Retrospective Cohort Study. J Minim Invasive Gynecol 2020; 27:697-703. [DOI: 10.1016/j.jmig.2019.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/07/2019] [Accepted: 06/08/2019] [Indexed: 11/16/2022]
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Current techniques and outcomes in hysteroscopic sterilization: current evidence, considerations, and complications with hysteroscopic sterilization micro inserts. Curr Opin Obstet Gynecol 2017; 29:218-224. [PMID: 28537948 DOI: 10.1097/gco.0000000000000369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW To describe the current data regarding effectiveness, complications, postoperative evaluation, and surgical interventions associated with Essure hysteroscopic sterilization. RECENT FINDINGS Hysteroscopic sterilization is a commonly performed procedure that is offered as a well tolerated, effective, outpatient method of permanent sterilization. Over the past several years, concerns have been raised regarding correct placement and postoperative complications. This has led to statements by both the Food and Drug Administration (FDA) in October, 2016 and American Association of Gynecologic Laparoscopists in February, 2017, as a significant portion of women seek removal of these devices. A current black-box warning issued by the FDA in 2016 recommends discussion of 'the probabilities of rates or events' of adverse outcomes associated with Essure placement. SUMMARY Although hysteroscopic sterilization is usually a safe, effective option for permanent contraception, new evidence regarding complications has emphasized the need for proper education and counseling. Appropriate patient selection and knowledge of potential complications is paramount to ensuring patients, and medical providers are well informed and have realistic expectations regarding potential placement and postoperative issues.
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Wahl H, Bell J, Skinner B. Laparoscopic Removal of a Retroperitoneal Hysteroscopic Microinsert Using Fluoroscopy. J Minim Invasive Gynecol 2017; 24:174-176. [PMID: 27687852 DOI: 10.1016/j.jmig.2016.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/15/2016] [Accepted: 09/18/2016] [Indexed: 11/16/2022]
Abstract
Perforation during placement of hysteroscopic microinserts for permanent sterilization occurs in approximately .9% to 2.6% of women undergoing the procedure. Most of the time perforation results in intraperitoneal placement of the hysteroscopic microinsert requiring laparoscopy or laparotomy for removal of the device. Herein we present a case of hysteroscopic microinsert perforation with subsequent retroperitoneal identification of the device. This is the first such case to our knowledge of retroperitoneal identification and retrieval of a perforated device that required real-time fluoroscopy during laparoscopy.
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Affiliation(s)
- Heather Wahl
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
| | - Jason Bell
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; Program on Women's Health Care Effectiveness Research, University of Michigan, Ann Arbor, Michigan
| | - Bethany Skinner
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; Division of Minimally Invasive Surgery, University of Michigan, Ann Arbor, Michigan
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Combined hysteroscopy-laparoscopy approach for excision of pelvic nitinol fragment from Essure contraceptive device: Role of intraoperative fluoroscopy for uterine conservation. Obstet Gynecol Sci 2016; 59:337-41. [PMID: 27462605 PMCID: PMC4958684 DOI: 10.5468/ogs.2016.59.4.337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/28/2016] [Accepted: 02/28/2016] [Indexed: 11/18/2022] Open
Abstract
We describe the successful removal of a pelvic contraceptive coil in a symptomatic 46-year-old patient who had Essure devices for four years, using a combined hysteroscopy-laparoscopy-fluoroscopy approach. Following normal hysteroscopy, at laparoscopy the right Essure implant was disrupted and its outer nitinol coil had perforated the fallopian tube. However, the inner rod (containing polyethylene terephthalate) had migrated to an extrapelvic location, near the proximal colon. In contrast, the left implant was situated within the corresponding tube. Intraoperative fluoroscopy was used to confirm complete removal of the device, which was further verified by postoperative computed tomography. The patient's condition improved after surgery and she continues to do well. This is the first report to describe this technique in managing Essure complications remote from time of insertion. Our case highlights the value and limitations of preoperative and intraoperative imaging to map Essure fragment location before surgery.
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Bowel perforation after placement of tubal occlusion contraceptive. Obstet Gynecol 2015; 125:860-862. [PMID: 25751196 DOI: 10.1097/aog.0000000000000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The tubal occlusion contraceptive provides a hysteroscopic technique for female sterilization. Efficacy of the tubal occlusion contraceptive relies on proper placement within the proximal aspect of the fallopian tubes. As long-term data become available, rates of complications are better defined. CASE This is a case of a patient who underwent placement of a tubal occlusion contraceptive. As a result of persistent pain and nausea, imaging was performed and malposition of the tubal occlusion contraceptive was identified. During laparoscopy, bowel perforation at the terminal ileum was diagnosed. Laparoscopic ileocecectomy was performed. CONCLUSION There should be a low threshold for evaluation of complications after tubal occlusion contraceptive placement. Although rare, bowel perforation after placement of the tubal occlusion contraceptive can occur. Laparoscopic management should be considered.
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Braginsky L, George ST, Locher SR. Management of perforated essure with migration into small and large bowel mesentery. J Minim Invasive Gynecol 2014; 22:504-8. [PMID: 25460518 DOI: 10.1016/j.jmig.2014.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 11/04/2014] [Accepted: 11/06/2014] [Indexed: 11/29/2022]
Abstract
The Essure permanent birth control system (Conceptus Inc, San Carlos, CA) is currently the only Food and Drug Administration-approved hysteroscopic sterilization method and has been widely accepted as a safe and effective procedure. We present a rare case of tubal perforation, coil fragmentation, and distal migration into small and large bowel mesentery 8 days after the insertion of the Essure device. We describe the successful management of this complication using laparoscopy and intraoperative fluoroscopy. Providers using Essure must be aware of the possibility of fragmentation of the Essure coils. Intraoperative imaging, ideally fluoroscopy, should be strongly considered in the management of Essure migration to ensure localization and full retrieval of Essure material.
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Affiliation(s)
- Lena Braginsky
- Advocate Illinois Masonic Medical Center, Chicago, Illinois.
| | - Sean T George
- Advocate Illinois Masonic Medical Center, Chicago, Illinois
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Ricci G, Restaino S, Di Lorenzo G, Fanfani F, Scrimin F, Mangino FP. Risk of Essure microinsert abdominal migration: case report and review of literature. Ther Clin Risk Manag 2014; 10:963-8. [PMID: 25484591 PMCID: PMC4240188 DOI: 10.2147/tcrm.s65634] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose To report a case of Essure microinsert abdominal migration and literature review. Methods A 41-year-old woman was counseled to undergo Essure sterilization. The procedure was hampered by the presence of endometrial cavity adhesions, obscuring left tubal ostium. By using microscissors the adhesions were progressively lysed. Since the procedure had become very painful, the patient required general anesthesia. Once adhesion lysis was completed, the tubal ostium was well visible. Both devices were then easily introduced into the fallopian tubes. At the end of the procedure, five coils were visible on the right side and five coils on the left side, as recommended. Results The 3-month hysterosalpingogram follow-up suspected abdominal migration of the left device. Laparoscopy confirmed the device displacement in the left lower abdominal quadrant. Both fallopian tubes and the uterus appeared normal. No signs of perforation were detected. The device was embedded into the omentum, but it was easily removed. Bilateral tubal sterilization was performed by bipolar coagulation. Conclusion There are only 13 cases, including the present, of Essure abdominal migration in the literature. In most cases, abdominal displacement of the microinsert is asymptomatic and does not induce tissue damage. However, in some cases, it may cause a severe adverse event, requiring major surgery. Therefore, removal of the migrated device should be performed as soon as possible. Moreover, during presterilization counseling, the patient should also be correctly informed about the risk of this rare but relevant complication, as well as about the surgical interventions that could be required to solve it.
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Affiliation(s)
- Giuseppe Ricci
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy ; Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Stefano Restaino
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Giovanni Di Lorenzo
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Francesco Fanfani
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Federica Scrimin
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Francesco P Mangino
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
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Adelman MR, Dassel MW, Sharp HT. Management of Complications Encountered With Essure Hysteroscopic Sterilization: A Systematic Review. J Minim Invasive Gynecol 2014; 21:733-43. [DOI: 10.1016/j.jmig.2014.03.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 03/20/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
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